IF YOU WOULD LIKE HELP TO GO THROUGH THE PAPER WORK AND FILL IN THE FORM, SIMPLY SEND ME THE FOR AND I WILL BE IN CONTACT
IF IT IS URGENT, THEN CALL ME ON 0458661034  DENISE LOVE

FACING THE QUESTTIONS IN THIS FORM CAN BE QUITE OVERWHELMING.  FEAR AROUND DYING IS NORMAL AND I AM HERE TO HELP YOU STEP THROUGH THIS. 

WE HAVE INCLUDED CHOICES YOU MAY NOT KNOW ABOUT. 

WE CAN 0FFER MORE INFORMATION ON THIS TOPICS

I LOOK FORWATD TO HEARING FROM  YOU TO SUPPORT YOU IN CRREATING A MEANINGFUL DOCUMENT THAT ALLOWS YOUR FAMILY OR FRIENDS TO BETTER UNDERSTAND YOUR NEEDS AND WANTS.  

iT IS IMPORTANT TO BE CLEAR THAT  IT IS NOT ALWAYS SUTIBLE FOR MANY REASONS THAT YOU WISHES ARE MET, BUT THE PEOPLE WHO ARE ORGANISING YOUR FINAL FARWELL FROM THIS EARTH CAN CRREATE SOMETHING THAT YOU WOULD HAVE BEEN COMFORTABLE WITH.

ONE OF THE MOST IMPORTANT OUTCOME OF RADING AND MAKING DECISION ABOUT YOUR END OF LIFE IS THAT YOU STEP THROUGH YOUR FEARS AROUND DEATH AND DYING.....AND BEGIN TO LIVE THE LIFE YOU CHOOSE FULLY.  

Have you Planned Ahead?

 

 

A few simple steps everyone can take for peace of mind giving time at a challenge transition in life to focus on relationships

 

Have you considered an End-of-life Doula?

 

 

Legal                  Medical              Funeral  Preferences.

 

 

 

 

 Have you planned your legal choices?

 

Everyone needs to set out their wishes in advance to begin the process of thinking about life.   When you better understand your choice, then the end of your life can be easier.  Make sure family and friends know about your wishes.   Ideally copies of this should be stored at home, Doctors office at solicitors, and at your chosen Funeral Directors, and your family should be told where to find them.  Place a note on your fridge about where to find them so if an ambulance offer is looking it is easy.  you can separate the document into 3 segmentss if you wish. 

 

Simply open the word document about in the green box, copy it once filled in and email or copy it and give it to your people of choice mentioned about


For your Will, if you haven" t got one you can download it    

https://legalwillkits.org/?gclid=CjwKCAjwltH3BRB6EiwAhj0IUCOZmzUemvaESCeUySI2-PAp3gSnXKrjZ44XQBmxYBxQ-dyS9N6tZRoCgggQAvD_BwE

Here is another choice to do it online      https://www.lawdepot.com/contracts/last-will-and-testament-au/?loc=AU&pid=googleppc-will_au-LastWillT1_aq11-ggkey_free%20will%20sample&gclid=CjwKCAjwltH3BRB6EiwAhj0IULXXT8aZjQK_Et4I2-bTWuHEL6aVfbvaDg8HopAPmBKp1PI39FxtMBoCs34QAvD_BwE#.XvVx1SgzbZs

 

Peope who are aware of your needs and wants and may hold documents
 

Contacts:     

 

Primary Next of Kin ____________________________________________________  elative or friend who you trust

                      Phone and email_________________________________________________________

                       

Alternative Next of Kin ________________________________________________

            Family important person ______________________________________________

            Solicitor__________________________________________________________________

            ____________________________________________________________________________

            Financial Power of Attorney ___________________________________________

            ____________________________________________________________________________

            Medical Power of Attorney ____________________________________________

            ____________________________________________________________________________

            Location of Will _________________________________________________________

            ____________________________________________________________________________

            Location of Medical Wishes  Advanced Directive (part of this document)___________________________________________

            ___________________________________________________________________________

             Who holds the Pre-Paid funeral _______________________________________A funeral can range from $1,200 for direct cremation to $12,000. Choose  independent   funeral directors in Australia for a more cost effective choice   

look here  https://www.funeraldirectorsaustralia.com.au/services/independent-funeral-directors/

          

             Location of Funeral Arrangements ___________________________________

 

  Social Media Information_______________________________________________

Facebook, etc

 

 

Have you planned the people to notify?

           

Employer/s                          _______________________________________________________

Doctor/s                               _______________________________________________________

                                                _______________________________________________________

Health Professionals             _______________________________________________________

   (e.g. Dentist, Physiotherapist) _______________________________________________________

                                                _______________________________________________________

Priest                                     _______________________________________________________

Landlord                               _______________________________________________________

Government          

Centrelink                                         (132 850)                        Medicare                   (132 011)

Dept Veterans’ Affairs                    (133 254)                        ATO                           (132 861)

Vehicle Rego & Licence                 (131 171)                        AEC (voting)             (132 326)

Local Council                       _____________________________________________________

Services                  

Electricity                             _______________________________________________________

Gas                                         _______________________________________________________

Telephone / Internet         _______________________________________________________

Water                                          _______________________________________________________

Post Office                            _______________________________________________________

Newsagent                           _______________________________________________________

Trade Union                                      _______________________________________________________

Clubs & Associations         _______________________________________________________

Financial                 

Bank/Credit Union                         _______________________________________________________

Superannuation Fund        _______________________________________________________

Health Benefits Fund         _______________________________________________________

Insurance (life, house, car) _______________________________________________________

Accountant                           _______________________________________________________

Financial Planner               _______________________________________________________

Please turn over to see my online accounts and passwords

 

Information Required for the Registration of a Death                                                                                                                              

Full name:  _____________________________________________________________________________

Address:    ______________________________________________________________________________

Occupation when working:  __________________________________________________________

Sex:      _____________                   Returned Services:                ______________

Religion:  _____________                           Type of Pension:  ______________

Date of Birth: _____________                   Place of Birth:  ______________

 

Year arrived Australia: _______                                       State arrived: ______________

 

Father’s Name: ___________________________________________________________________

 

Fathers Occupation:  __________________________________________________________________

 

Mother’s Name:  __________________________________ (Maiden name):  _________________
 

Mother’s Occupation:  ________________________________________________________________

 

No. of Marriages/Relationships:  ________ Present Marital status:  ________________

 

1.  Where                                        2.  Where                                                            3.  Where

      Date                                                 Date                                                                 Date

      To Whom                                       To Whom                                                                 To Whom

 

Names of children (including deceased children) and dates of birth: 

 

 

 

 

 

 

 

 

 

 

 

_

 Have you Planned your health choices?

 

A few guidelines (a simple Advanced Care Plan) might your family to make decisions relating to your health preferences.

This is sufficient for your wishes to be carried out……but some states and institutions are requesting their documents are completed. 

Your choice whether you fill them in.  All documents are as legally binding unless someone contests them……and even wills are constantly

contested and changed.

 

Choice of Medical Agent/Medical Power of Attorney.

I understand that my medical agent/medical power of attorney will be able to do the following if I am not able to:

  1. Make medical choices for me.

  2. Agree or refuse treatment for me.

  3. Interpret instructions on this form for me.

  4. Make decisions on when to refuse ongoing treatments/life support.

  5. Authorise release of my medical records if needed.

  6. Authorise medications and pain treatments for me.

  7. Communicate my wishes regarding organ/tissue donations.

(I understand I can revoke this authority at any time.)

The person I want to make medical treatment decisions for me is:

Primary Medical Agent/POA:      Name:  _______________________________________________

Address:  _______________________________________________________________________________

Phone/s _______________________________________________________________________________

 

Secondary Medical Agent/POA:  Name _____________________________________________

Address:  _______________________________________________________________________________

Phone/s _______________________________________________________________________________

 

Signing and witnessing this double page forms an Advanced Care Plan

Signature:   ___________________________                Date:             ___________________________

Witness:       ___________________________                Date:             ___________________________

Witness:       ___________________________                Date:             ___________________________

The Kind of Medical Treatment I want/don’t want.

 

I am open to the idea of Death with Dignity (Euthanasia) when it is legal

https://www.dwdv.org.au/  read this so you understand. 

 

If life support treatment will only delay my death, I:

1.          Want to have Life Support.                                                                        ☐

2.          Do not want to have Life Support.                                                         ☐

3.          Want to delegate decisions to my Medical Agent.                                        ☐

 

If I am in a coma and not expected to wake up or recover, I:

1.          Want to have Life Support.                                                                        ☐

2.          Do not want to have Life Support.                                                          ☐

3.          Want to delegate decisions to my Medical Agent.                                        ☐

 

If I have permanent and irreversible brain damage and am not expected to wake up or recover, I:

1.          Want to have Life Support.                                                                        ☐

2.          Do not want to have Life Support.                                                          ☐

3.          Want to delegate decisions to my Medical Agent.                                        ☐

 

Any other conditions under which I do not wish to be kept alive:

 

 

Use of Pain killing and comfort drugs____________________________________               Yes please                ☐

 

Keep me totally comfortable even if it shortens my life                            ☐                                    

 

Awake as much as possible_______________________________________________     ☐   

 

If I choose to withdraw from food and water, please let me                         ☐

 

Please let me die in my own time without pushing me to live                     ☐                 

 

These decisions can be formalized by filling out a Refusal of Treatment certificate, which may be obtained from your GP.  Not necessary but some people feel more comfortable filling in a formal form…. give a copy of this to your GP

Location of Refusal of Treatment Certificate:  ___________________________________________________

 

 

Other wishes, need and wants

 

How I want people to treat me during illness or my last little time on earth

 

If life support treatment will only delay my death, I:

                                                                                                                                    Yes     No

1.        Medical treatment discussions in my room?                            ☐    ☐

2.        Medical treatment discussions with family present?                   ☐    ☐

3.        Medical treatment discussions only with my medical agent?   ☐    ☐

4.        I want to have people present at in my last hours?                   ☐    ☐

 

Particular people I would like present:   ____________________________________________ __________________________________________________________________________________________

Particular people I would welcome visits from (priests, colleagues, etc.):   __________________________________________________________________________________________

__________________________________________________________________________________________

People I would like to exclude please_______________________________________________

If it can be done, I want to die at:

1.        My Home.                                                                                                    ☐

2.        Palliative Care/Hospice.                                                                        ☐

3.        Age Care Facility/Nursing Home.                                                            ☐

4.        Hospital.                                                                                                      ☐
5.        Not important to me.                                                                              ☐

                                  

My other Preferences:

Organ/Medical Donations: _______________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________
 

Arrangements for my Pets: _______________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________
 

My Electronic Media Accounts are: ________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Person I authorize to deal with them:        __________________________________________
 

Family & Friends I would like notified of my illness (name, address or phone):

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

 

Forwarded The medical pages of this document to the to your GP separately from the rest of the booklet. Copies should also be left with your family or solicitors.  Place a copy of your Medical Directive somewhere obvious, with a note of the fridge where it can be found.
Signing and witnessing this double page forms an Advanced Care Plan

 

Have you Planned your funeral choices?

 

Did you know you don’t have to have a funeral?  You can die at home, have your body in a coffin or wrapped in a shroud brought home for a family and friends gathering for a day or a few hours and or you can go straight to the crematorium at minimum costs.  Gatherings are often of advantage for the grieving people who care about you…. let them consider this if you don’t care at their cost!

 

Putting what you would want in writing ensures that you get what you would want and takes away later uncertainty at a time when your family is under stress anyway.  Issues around recognized partners by family, religious beliefs that differ in families and cultural issues can cause lots of issues at your time of death, if it is not very clear and plan.

 

Decisions might be big expensive ones – like where to purchase a single grave or a double grave – or small simple ones – like which Song could be played

 

  • Pre-Arranging a funeral involves sorting out the details amongst the family beforehand

  • Pre-Payment takes pre-arrangement to the next level and invests for the planned funeral at today’s prices. This can be done up front, or on a payment plan, and the funds are securely invested. (This option also reduces assessable assets for calculating pension payments.) It is in the form of a bond and is transferable between funeral homes.

  • Funeral Insurance (which is often advertised as an alternative to pre-paying a funeral), should probably be treated with caution.

Funeral Type

 

Home                              _______________________________________________________

 

Funeral location: ______________________________________________________________

 

Burial or Cremation: ______________________________________________________________

 

Grave Location: ______________________________________________________________

 

There is no law that says you need to have a funeral.  You can have casual gatherings or memorial services at home.  You can go straight from the hospital to cremation or burial if you choose.  Burial is much more expensive.  Ashes can be keep or scattered…..our choice. 


Ashes instructions: ______________________________________________________________

           

 

 

 

Funeral         

 

I would like a Green funeral   ☐                    I don’t care    ☐    Stay at home after I die     ☐  Take me home for a vigil, people sitting with me -4 hours ☐  1 day ☐  3 day ☐  up to you ☐             I would like a vigil at the Funeral home       ☐      Please leave my body to rest, I am fine on my own to allow the time I need to finish life     ☐      Hire a cold plate or blanket    ☐       Just use ice or frozen hot water bottles    ☐Leave me in the clothes I die in    ☐Dress me in special clothes which I have picked    ☐Wash my body   ☐      Face and hands only    ☐    clean me up if I need it     ☐     No wash ☐     Shroud only, no coffin     ☐    Wrap me gently in a cotton sheet as a shroud ☐Place me in an open coffin     ☐Place me in a closed coffin at home    ☐Let the funeral home care for me but no extras    ☐Just have a normal funeral, whatever that is     ☐No embalming please        ☐No mouth stitch please      ☐My choice of coffin is     ☐ As green as possible    ☐ Anything my family chooses  Untreated pine  ☐      Cardboard   ☐     Homemade ☐      Wool   ☐     Wicker  ☐     Shroud   ☐

If you choose a conventional funeral, then it is best to find an independent funeral director who is able to service you with caring cost-effective services.  There are plenty.  Just be aware that many are part of a huge international organization and are less likely to individualise your needs.

 

All the coffins suggested can be painted, lined and decorated.  You can place a sheet shrouded person inside and have the coffin at home to decorate in advance, as someone is dying or anytime you wish.  Independent funeral directors will support you if you require transports, help dressing or organizing things.  There are many wonderful supported Funeral Directors available

 

Songs you would like played or sung _________________________________________________________________________________________________________
 

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

Readings                                                   Reading:                                         Reader:

                           1st                       ______________________     _____________________________

                           2nd                     ______________________                 ____________________________

                           Other               _______________________    ____________________________

Pall-bearers                              _______________________              ______________________ _______________________

                                                       ______________________              ______________________  _______________________

 

 

Poem or Reflection: ______________________________________________________________

 

Refreshments at: ______________________________________________________________

 

Special instructions: ______________________________________________________________

 

                        __________________________________________________________

 

Other Requests:

 

Music at Graveside: ______________________________________________________________

 

Ashes Instructions: ______________________________________________________________

 

Special instructions: ______________________________________________________________

 

                           ______________________________________________________________

 

                           ______________________________________________________________

 

This double-sided insert form re your funeral wishes can be separate from the other 2 pages, photocopied, and forwarded to your chosen funeral director separately from the rest of the booklet.
Copies should also be left with your family or solicitors.

 

 

 

 

 

 

 

 

 

 

By taking responsibility for your life now, means your end-of-life is less challenging.  You can embark on living fully until you die……Death is not the enemy, not living life is

 

 

If you would like no obligation assistance with this document, contact:

LifeOptions

Death Doula’s: Denise Love deniselovelifeoptions@gmail.com

I have been a Registered Nurse for 45 years, a Palliative Care Nurse for 8 years and a Death Doula for many.

Death Doula: Denise Love deniselovelifeoptions@gmail.com  

I am passionate about the way we are born, live and die

I have served many families and dying people and find it such a special time in life. 

(or Nigel 03 9489 8711 or at info@ravensfunerals.com.au )
 

 

Cal/amcos licensed